Provider Demographics
NPI:1154547461
Name:PHILLIPS, SARA J
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:J
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:719 S SCHELL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2035
Mailing Address - Country:US
Mailing Address - Phone:856-371-7570
Mailing Address - Fax:
Practice Address - Street 1:719 S SCHELL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2035
Practice Address - Country:US
Practice Address - Phone:856-371-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009782235Z00000X
NJ41YS00615400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist